Folate deficiency

ICDO =
OMIM =
MedlinePlus = 000354
eMedicineSubj = med
eMedicineTopic = 802
MeshID = D005494
Signs of folic acid deficiency are often subtle.

Presentation

Diarrhea, loss of appetite, and weight loss can occur. Additional signs are weakness, sore tongue, headaches, heart palpitations, irritability, and behavioral disorders. cite journal | author=Haslam N and Probert CS. | title=An audit of the investigation and treatment of folic acid deficiency | journal=Journal of the Royal Society of Medicine | volume=91 | issue=2 | year=1998 | pages=72–3 | pmid=9602741]

Women with folate deficiency who become pregnant are more likely to give birth to low birth weight and premature infants, and infants with neural tube defects.

In adults, anemia (Macrocytic, Megaloblastic anemia) is a sign of advanced folate deficiency.

In infants and children, folate deficiency can slow growth rate.

Late studies suggested an involvement in tumorogenesis (especially in colon) through demethylation/hypomethylation of fast replicating tissues.

Some of these symptoms can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

Causes

A deficiency of folate can occur when the body's need for folate is increased, when dietary intake of folate is inadequate, or when the body excretes (or loses) more folate than usual. Medications that interfere with the body's ability to use folate may also increase the need for this vitamin. cite journal | author=Oakley GP Jr, Adams MJ, Dickinson CM | title=More folic acid for everyone, now | journal=Journal of Nutrition | volume=126 | issue=3 | year=1996 | pages=751S–755S | pmid=8598560] cite journal | author=McNulty H| title=Folate requirements for health in different population groups| journal=British Journal of Biomedical Science| volume=52| issue=2 | year=1995| pages=110–9 | pmid=8520248] cite journal | author=Stolzenberg R| title=Possible folate deficiency with postsurgical infection| journal=Nutrition in Clinical Practice | volume=9| issue=6| year=1994| pages=247–50 | pmid=7476802| doi=10.1177/0115426594009006247] cite journal | author=Pietrzik KF and Thorand B | title=Folate economy in pregnancy | journal=Nutrition | volume=13 | issue=11-12 | year=1997 | pages=975–7 | pmid=9433714 | doi=10.1016/S0899-9007(97)00340-7] cite journal | author=Kelly GS | title=Folates: Supplemental forms and therapeutic applications | journal=Altern Med Rev | volume=3 | issue=3 | year=1998 | pages=208–20 | pmid=9630738] cite journal | author=Cravo ML, Gloria LM, Selhub J, Nadeau MR, Camilo ME, Resende MP, Cardoso JN, Leitao CN, Mira FC | title=Hyperhomocysteinemia in chronic alcoholism: correlation with folate, vitamin B-12, and vitamin B-6 status | journal=The American journal of clinical nutrition | volume=63 | issue=2 | year=1996 | pages=220–4 | pmid=8561063] Some research indicates that exposure to ultraviolet light, including the use of tanning beds, can lead to a folic acid deficiency. [http://www.americanpregnancy.org/pregnancyhealth/tanningmethods.html]

ituational

Some situations that increase the need for folate include:
* pregnancy and lactation (breastfeeding)
* alcoholism
* tobacco smoking
* malabsorption, including celiac disease
* kidney dialysis
* liver disease
* certain anemias.

Medicational

Medications can interfere with folate utilization, including:

* anticonvulsant medications (such as phenytoin, and primidone)
* metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
* sulfasalazine (used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis)
* triamterene (a diuretic)
* methotrexate, an anti-cancer drug also used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis.

Folic acid supplements are normally given with sulfasalazine. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate "de novo" purine and pyrimidine synthesis and cell division. It may therefore be counter-productive to take a folic acid supplement with methotrexate. Although the folic acid inhibition of sulfasalazine is normally seen as a side effect, it is possible that it is a part of the therapeutic effect of the drug, given that methotrexate, a frank folic acid inhibitor, is often given if sulfasalazine fails. It would therefore be wise to consult with a physician before taking a folic acid supplement along with sulfasalazine or methotrexate.

Prevention and treatment

When cooking, use of steaming or of a food steamer can help keep more folate content in the cooked foods, thus helping to prevent folate deficiency (see USDA reference in the steaming article).

References

External links

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